A dental crown is a highly versatile dental restoration. It is one of the most popular reconstructive dentistry procedures because it can be used in many different situations for dramatic effect. A crown has the potential to save a badly damaged tooth, providing a long-term solution to many common dental problems.
At the office of Las Vegas dentist Dr. James B. Polley, we have helped many patients achieve attractive, durable results with dental crowns. To help you understand when and why this procedure might help, we offer this complete guide.
WHAT IS A DENTAL CROWN?
A dental crown, also known as a “cap,” is a dental restoration that completely covers the portion of a tooth above the gums.
What a Dental Crown Can Do
Dental crowns are very versatile restorations. They can be used to:
- Restore teeth with large cavities that can’t be filled
- Restore teeth after a failed filling
- Support cracked, badly worn, or weak teeth
- Protect teeth treated with a root canal
- Support a dental bridge
- Top of dental implant
- Achieve cosmetic dentistry goals
When Is a Filling Too Large?
In truth, it is possible to place fillings on a cavity that is of any size. However, the larger the cavity, the more a filling will impact the strength of the tooth. Recommendations vary, but the most common recommendation is that a filling should not take up more than ⅓ the surface between the cusps of a tooth, nor should it involve more than two surfaces of a tooth.
This is true of primary fillings (placed on a tooth that didn’t have a filling) or replacement fillings.
Does a Root Canal Require a Crown?
In root canal therapy, we remove the living pulp at the center of a tooth. The space is then filled with an inert material with similar physical properties. This doesn’t inherently mean that it needs a dental crown. It depends on the size of the hole used to remove the pulp material.
When Is a Crown Better Than a Veneer for Cosmetic Dentistry?
Usually, we use dental veneers for cosmetic dentistry. A veneer is a restoration that covers one visible side of a tooth, potentially extending over the biting edge, called the incisal edge. Veneers are normally used for the incisors (the front four teeth), canines (the teeth on either side that are often sharp), and sometimes premolars (the next two teeth on either side). Dental crowns can be used for any teeth.
Veneers are normally used only for cosmetic purposes. Crowns can be used for cosmetic purposes when the procedure significantly changes the shape of the tooth, adding or removing a significant amount of natural tooth material.
TYPES OF DENTAL CROWNS
Over time, dental crowns have been made of many different materials, depending on what materials were available and appropriate for the application. In general, we can break these materials down into three categories: metals, plastics, and ceramics. In some situations, we can use bimaterial crowns.
At the office of Dr. James B. Polley in Las Vegas, we prefer to use all-ceramic crowns, relying on plastic restorations only as temporaries.
Metal was the first material used for dental crowns. For many years, gold was the only option available. They are still in use today, although they are generally less popular because of the fluctuating price of gold, their high visibility, and their conductivity of heat.
Other metals used include stainless steel (usually only temporary restorations, especially used on primary teeth), base metal alloys, and noble metal alloys.
Typically, plastic crowns are used as temporary restorations. Although they can fit well and may even look attractive, they are not very durable. The two most common types of plastics used are acrylic, which is scratch-resistant, but more likely to fracture, and polycarbonate, which is resistant to fractures but can scratch easily.
In the past, the only ceramic used for crowns was porcelain. These were attractive, but not very durable, so they were limited to the front of the mouth. Advances in ceramic technology mean that modern ceramics include lithium silicate and zirconia. Lithium silicate is much stronger than porcelain, but still isn’t considered strong enough for molars. Zirconia is as strong as titanium under compression, and can be used anywhere in the mouth. However, it is less attractive than lithium silicate, so it’s usually used on the molars.
Sometimes, we try to improve the performance of a dental crown by using a combination of materials. Porcelain-fused-to-metal (PFM) crowns were popular because they promised the strength of metal with the appearance of ceramic. However, these have become less popular as new ceramic materials have made them largely obsolete.
Sometimes, crowns are made with two different ceramic materials, typically a zirconia core covered by a lithium silicate facade.
THE DENTAL CROWN PROCEDURE
Placing these restorations is a complicated process. Typically, the process is broken down into three visits: consultation, preparation, and fitting.
Your initial consultation may take place at a routine checkup and cleaning or it could be a separate visit. During your consultation, we will evaluate your teeth to determine whether a dental crown is the best solution for your tooth. We will also consider whether the tooth might need root canal therapy, or if it might be better to extract than try to preserve the tooth. Usually, we prefer to save the tooth, but there are situations where extraction is necessary.
Once we have decided a crown is the best solution, we will usually schedule a separate visit to prepare the tooth. However, if time is available or if the situation is dire, we may proceed immediately to the preparation and impressions stage.
Preparation and Impressions
We have to remove natural tooth material to make room for your restoration. This is called “preparation.” The amount of tooth material removed and the shape of the prepared tooth depends on the type of material used and the dentist’s personal style.
Once your teeth are prepared, we will take impressions of your teeth for the dental lab to use to prepare your dental crowns.
In the past, impressions were made with teeth in physical impression material. These days, we can rely on digital impressions, created by literally waving a wand over your teeth.
Before you leave, we will fashion a temporary that will protect your tooth and its preparation until your final restoration is ready.
When your final dental crown is ready, we will schedule an appointment for you to have it fitted. This is usually 1-2 weeks after the preparation visit, but in some cases we can ask the lab to rush the job. (Or prepare it in-house using our same day procedure (see below).)
We will inspect the crown to make sure it fits the specifications. Then you will try it in for fit. We will compare the color and luster against your natural teeth to make sure it looks right.
We will test your bite to make sure your teeth are coming together properly. You can tell us if it feels too high, isn’t contacting at all, or has other fit problems. Usually, we will then cement your restoration in place, but if it has problems we may have to contact the lab and have it remade.
Same-Day Dental Crowns
At the office of Dr. James B. Polley in Las Vegas, we offer same-day dental crowns, an alternative to the traditional two visits for preparation and fitting. We can consolidate the two visits into one. First, we will prepare the teeth and take a digital impression.
Then we will design your restoration so it fits in with your neighboring and opposing teeth. Then we will feed the instructions into the CEREC system, which mills the dental crown from advanced ceramics, like lithium silicate and zirconia.
Once the restoration is milled, it can have its color adjusted. It will be polished and glazed. We will test the fit, then cement the cap, all in the same dental visit.
CARING FOR YOUR DENTAL CROWN
In general, crowned teeth don’t require any special care. Just brush and floss normally. Make your regular dental checkups. Although dental crowns don’t develop cavities, you can develop cavities at the edge of the restoration (also called the margin). This should be protected by your gums. However, if you experience receding gums, it can expose the margin.
Here are some things to keep in mind to help extend the life of your restoration.
Avoid Abrasive Toothpaste
Gum disease is the most common cause of receding gum. However, aggressive toothbrushing is almost as common. Make sure you brush twice a day, but more than that is not necessary. Use a toothbrush that has soft bristles, and consider using a toothbrush that has a pressure sensor so you don’t push too hard.
Don’t Use Your Teeth as Tools
Biting into nonfood objects or using your teeth to tear open or twist off lids of food and drinks can damage crowns. Your crown isn’t made for these uses, and they can lead to premature wear or damage.
Wear a Mouthguard
Modern dental materials are very strong, but they can be damaged in certain situations. You can reduce the risk of damage to your restorations by wearing a mouthguard.
Don’t forget: mouthguards aren’t just for full-contact sports. Tooth injury is common in basketball, cycling, equestrian events, and other sports.
Most dental crowns are successful without significant problems. However, there are some problems that can develop.
Some amount of tooth discomfort is normal after placing a dental crown. You’re more likely to feel discomfort after the preparation stage, as vibrations from removing tooth material can cause inflammation in the pulp of the tooth (pulpitis). This should resolve in a few days to a week. By the time your permanent restoration is ready, it will likely be gone. If not, make sure you let us know.
When we cement your permanent crown, discomfort should be very short-term, resolving in a day or two. Contact us if it persists for a week or seems to get worse.
Sometimes, your tooth may be sensitive to heat or cold after you get a dental crown. Since some of your natural tooth material has been removed, the pulp is now closer to the surface, and is more exposed to temperature variations. This is more common with metal restorations, which conduct heat well. However, it can occur with ceramic crowns as well.
Porcelain and old PFM crowns were vulnerable to chipping. Modern ceramic restorations can chip, but it is rare.
A crown should be cemented firmly to your tooth, but sometimes they can come loose. A loose crown can encourage decay underneath it. Please contact us so we can cement the restoration.
Bite Feels Wrong
Your restoration should feel natural, like it fits with your other teeth. However, sometimes a dental crown may feel off. If this is the case, contact us for a follow-up appointment where we will check the fit.
Crown Falls Off
Other times, a restoration may actually come off your tooth. If this happens, contact us immediately. We’ll try to get you in as soon as possible, and we’ll give you instructions on how to handle the situation in the meantime.
You may be happy with the fit and function of your dental crown, but not the appearance. Appearance problems that occur include poor color match, a dark line at the margin (related to PFM crowns), staining, or scratches. Usually, the only remedy for these problems is replacement of the restoration.
How Long Do Dental Crowns Last?
The longevity of your dental crowns depends on the material you chose, how well they are designed and fitted, and how well you care for them.
Almost all last at least five years, unless there is a major unforeseen circumstance. Ceramic dental crowns usually last 10-15 years. Some can last even longer.
How Much Do Crowns Cost?
The actual cost of your restoration depends on the chosen material, the procedure you select, and your insurance coverage. The average cost of dental crowns in Las Vegas is about $1600 dollars. We offer financing options to help people afford the dental crowns they need.
Have More Questions about Dental Crowns in Las Vegas?
We hope we have answered all general questions you may have about dental crowns, but if you have specific questions related to your oral health or dental needs, please call (702) 873-0324 to schedule an appointment at the office of Dr. James B. Polley in Las Vegas.